A disturbing new story out of Michigan highlights how female genital mutilation is a very real issue in the U.S. The Detroit Free Press reported yesterday that a Detroit-area physician, Jumana Nagarwala, M.D., has been charged with performing female genital mutilation (FGM) on multiple young girls, ranging from six to eight years old, at a medical clinic in Livonia, Michigan.

FGM is a surgical procedure, typically defined as a non-medically necessary procedure causing injury to the female genital organs. It often involves the partial or complete removal of external female genitalia, like the clitoris. The surgery has no health benefits for the girls and women who receive it, and it can lead to consequences like difficulty urinating, cysts, infections, complications in childbirth, and severe bleeding. Some cultures and societies rationalize FGM as a rite of passage into womanhood, but it's recognized internationally as an act of violence against girls and women. FGM affects more than 200 million women and girls around the world, according to Equality Now. UNICEF has found that the practice is highly concentrated in areas of Africa and the Middle East—with Somalia, Guinea, and Egypt having the highest FGM rates.

The procedure is illegal in the U.S., but it's still a problem here. A study from the CDC estimated that in 2012, 513,000 women and girls in the U.S. had undergone or were at risk of being subjected to FGM. However, the current case in Michigan is believed to be the first criminal case related to FGM in the U.S., the Free Press reports.

The criminal complaint states that the parents of two of Nagarwala’s victims traveled from Minnesota to bring their daughters to her. The girls were told they were going on a "special girls' trip," but they really went to a clinic to see Nagarwala. One victim told an FBI child forensic interviewer that Nagarwala "pinched" her on the "place [where] she goes pee pee" and afterwards she was given a pad to wear in her underwear. She was told not to talk about the procedure. The other victim told the FBI that after her procedure, she "could barely walk, and that she felt pain all the way down to her ankle." Back in Minnesota, a medical doctor examined both victims and found abnormalities and alterations in their genitals. The Free Press reports that the FBI has identified several other children who Nagarwala potentially victimized between 2005 and 2007.

Nagarwala appeared in court for the first time on Thursday, and she will remain in custody until a hearing on Monday, when a judge will decide to grant her bond or keep her in custody until the end of her trial. Performing FGM is punishable by up to five years in prison in the U.S. Nagarwala has already been put on administrative leave by Henry Ford Hospital, where she worked as an emergency room doctor.